1033706270 NPI number — ANEW VISION COUNSELING SERVICES PLLC

Table of content: DR. EBY LUDERA BANAS M.D. (NPI 1245388776)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1033706270 NPI number — ANEW VISION COUNSELING SERVICES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANEW VISION COUNSELING SERVICES PLLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1033706270
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5505 DOVERSTONE CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28208-2472
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
704-965-0213
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10801 JOHNSTON RD STE 226
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLOTTE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28226-7856
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
980-299-1277
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
12/22/2020

Additional Information

Authorized Official

Authorized Official Last Name:
DOSTER
Authorized Official First Name:
DENISE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER/THERAPIST
Authorized Official Telephone Number:
704-965-0213

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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